KDPI mapping vs. SCD, ECD, DCD Aaron Cohen Manager of Donor Referral and Allocation

Total Organ Donors KDPI distribution

Match System – Sequences A-D Sequence A KDPI ≤ 20% Sequence B KDPI > 20% - 34% Sequence C KDPI 35% - 85% Sequence D KDPI 86% - 100% Highly Sensitized 0-ABDRmm (top 20% EPTS) Prior Living Donor Local pediatrics Local top 20% EPTS 0-ABDRmm (all) Local (all) Regional pediatrics Regional (top 20% EPTS) Regional (all) National pediatrics National (top 20% EPTS) National (all) 0-ABDRmm Local adults Regional adults National Pediatrics National Adults Local Regional National Local + Regional *all categories in Sequence D are limited to adult candidates

All Donors Sequence A KDPI distribution KDPI Score Range  1-20 % 1-20 Total Donors Highly Sensitized 0-ABDRmm (top 20% EPTS) Prior Living Donor Local pediatrics Local top 20% EPTS 0-ABDRmm (all) Local (all) Regional pediatrics Regional (top 20% EPTS) Regional (all) National pediatrics National (top 20% EPTS) National (all) SCD 51 22% 231 ECD 0% 58 DCD 5 10% 49 Total 56 17% 338

All Donors Sequence B KDPI distribution KDPI Score Range  21-34 % 21-34 Total Donors Highly Sensitized 0-ABDRmm Prior Living Donor Local pediatrics Local adults Regional pediatrics Regional adults National Pediatrics National Adults SCD 47 20% 231 ECD 0% 58 DCD 7 14% 49 Total 54 16% 338

All Donors Sequence C KDPI distribution KDPI Score Range  35-85 % 35-85 Total Donors Highly Sensitized 0-ABDRmm Prior Living Donor Local Regional National SCD 128 55% 231 ECD 17 29% 58 DCD 33 67% 49 Total 178 53% 338

All Donors Sequence D KDPI distribution KDPI Score Range  86-100 % 86-100 Total Donors Highly Sensitized 0-ABDRmm Local + Regional National *all categories in Sequence D are limited to adult candidates SCD 5 2% 231 ECD 41 71% 58 DCD 4 8% 49 Total 50 15% 338

Txp Kidney Donor KDPI Distribution

Txp Kidney Donors Sequence A KDPI distribution KDPI Score Range  1-20 % 1-20 Total Donors Highly Sensitized 0-ABDRmm (top 20% EPTS) Prior Living Donor Local pediatrics Local top 20% EPTS 0-ABDRmm (all) Local (all) Regional pediatrics Regional (top 20% EPTS) Regional (all) National pediatrics National (top 20% EPTS) National (all) SCD 49 25% 231 ECD 0% 58 DCD 4 10% Total 53 20% 338

Txp Kidney Donors Sequence B KDPI distribution KDPI Score Range  21-34 %21-34 Total Donors Highly Sensitized 0-ABDRmm Prior Living Donor Local pediatrics Local adults Regional pediatrics Regional adults National Pediatrics National Adults SCD 44 22% 231 ECD 0% 58 DCD 7 18% 49 Total 51 19% 338

Txp Kidney Donors Sequence C KDPI distribution KDPI Score Range  35-85 % 35-85 Total Donors Highly Sensitized 0-ABDRmm Prior Living Donor Local Regional National SCD 105 53% 231 ECD 10 37% 58 DCD 26 67% 49 Total 141 338

Txp Kidney Donors Sequence D KDPI distribution KDPI Score Range  86-100 % 86-100 Total Donors Highly Sensitized 0-ABDRmm Local + Regional National *all categories in Sequence D are limited to adult candidates SCD 2 1% 231 ECD 17 63% 58 DCD 5% 49 Total 21 8% 338

Declined Kidney Donor KDPI Distribution

Donors with declined Kidneys Sequence A KDPI distribution KDPI Score Range  1-20 % 1-20 Total Donors Highly Sensitized 0-ABDRmm (top 20% EPTS) Prior Living Donor Local pediatrics Local top 20% EPTS 0-ABDRmm (all) Local (all) Regional pediatrics Regional (top 20% EPTS) Regional (all) National pediatrics National (top 20% EPTS) National (all) SCD 2 9% 231 ECD 0% 58 DCD 1 11% 49 Total 3 5% 338

Donors with declined Kidneys Sequence B KDPI distribution KDPI Score Range  21-34 %21-34 Total Donors Highly Sensitized 0-ABDRmm Prior Living Donor Local pediatrics Local adults Regional pediatrics Regional adults National Pediatrics National Adults SCD 1 4% 231 ECD 0% 58 DCD 49 Total 2% 338

Donors with declined Kidneys Sequence C KDPI distribution KDPI Score Range  35-85 % 35-85 Total Donors Highly Sensitized 0-ABDRmm Prior Living Donor Local Regional National SCD 19 83% 231 ECD 7 24% 58 DCD 6 67% 49 Total 32 52% 338

Donors with declined Kidneys Sequence D KDPI distribution KDPI Score Range  86-100 % 86-100 Total Donors Highly Sensitized 0-ABDRmm Local + Regional National *all categories in Sequence D are limited to adult candidates SCD 1 4% 231 ECD 22 76% 58 DCD 2 22% 49 Total 25 41% 338

Averages 2014 Average OL donor KDPI Score: 53% Average Txp Kidney KDPI score: 46% Average Rejected Kidney KDPI score: 74%

Averages 2015 Average OL donor KDPI Score: 56% 52% on donors where Kidney offers made Average Txp Kidney KDPI score: 42% Average Rejected Kidney KDPI score: 79%

Future plans OL to monitor acceptance behavior after implementation of KAS During scheduled Organ Offer reviews, KDPI will be emphasized. Local vs. Regional to be reviewed

Update for 2015 Began looking at center specific acceptance/declines based on KDPI. Mapped out acceptance behavior with local centers and provide information to all centers.

Acceptance Behavior Mapping KDPI Distribution 12-4-14 to 2-28-15 Center Offered Accepted Declined Transplanted Total offers Center 1 15% 12% 16% 11% 22 Center 2 50% 37% 63% 45% 96 Center 3 48% 42% 58% 69 Center 4 39% 57% 30% 73 Center 5 55% 44% 68% 56% 91 Center 6 53% 62% 14% 50 Center 7 36% 52 Center 8 40% 65% 35% 82 Center 9 52% 69% 43% 113 Center 10 49% 67% 33%

Future plans Partnering with Tx centers to review acceptance behavior. Utilize the data for long term decision making???